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3.4.12 Traumatic Brain Injury (TBI).

Key Topics: Referral School Re-EntryTBI Manual

Definition

"Traumatic brain injury" means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that may adversely affect a child's educational performance and result in the need for special education and related services. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as: cognition, speech/language, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual and motor abilities, psychosocial behavior, physical functions, and information processing. The term does not apply to brain injuries that are congenital or degenerative, or brain injuries induced by birth trauma. (M.R. 3535.1348)

 

Criteria

The team shall determine that a pupil is eligible and in need of special education and related services if the pupil meets the criterion in item A and in items B and C as documented by the information gathered according to item D:

  1. There is documentation by a physician of a medically verified traumatic brain injury.
     

  2. There is a functional impairment attributable to the traumatic brain injury that adversely affects educational performance in one or more of the following areas: intellectual-cognitive, academic, communication, motor, sensory, social-emotional/behavioral, and functional skills/adaptive behavior. Examples of functional impairments, which may adversely affect educational performance, are:

    (1) Intellectual-cognitive, such as, but not limited to, impaired:

    1. attention or concentration;

    2. ability to initiate, organize, or complete tasks;

    3. ability to sequence, generalize, or plan;

    4. insight/consequential thinking;

    5. flexibility in thinking, reasoning, or problem-solving;

    6. abstract thinking;

    7. judgment or perception;

    8. long-term or short-term memory;

    9. ability to acquire or retain new information;

    10. ability to process information.

    ( 2) academic, such as but not limited to:

    1. marked decline in achievement from pre-injury levels;

    2. impaired ability to acquire basic skill (reading, written language, mathematics);

    3. normal sequence of skill acquisition which has been interrupted by the trauma as related to chronological and developmental age.

    (3) communication, such as, but not limited to:

    1. impaired ability to initiate, maintain, restructure, or terminate conversation;

    2. impaired ability to respond to verbal communication in a timely, accurate or efficient manner;

    3. impaired ability to communicate in distracting or stressful environments;

    4. impaired ability to use language appropriately (requesting information, predicting, analyzing, or using humor);

    5. impaired ability to use appropriate syntax;

    6. impaired abstract or figurative language;

    7. perseverative speech (repetition of words, phrases, or topics);

    8. impaired ability to understand verbal information;

    9. impaired ability to discriminate relevant from irrelevant information;

    10. impaired voice production/articulation (intensity, pitch, quality, apraxia, or dysarthria).

    (4) motor, such as, but not limited to, impaired:

    1. mobility (balance, strength, muscle tone, or equilibrium);

    2. fine or gross motor skills;

    3. speed or processing or motor response time;

    4. sensory/perceptual motor skills;

    (5) sensory, such as, but not limited to impaired:

    1. vision (tracking, blind spots, visual field cuts, blurred vision, or double vision);

    2. hearing (tinnitus, noise sensitivity, or hearing loss).

    (6) social-emotional-behavioral, such as, but not limited to:

    1. impaired ability to initiate or sustain appropriate peer or adult relationships;

    2. impaired ability to perceive, evaluate, or use social cures or context appropriately;

    3. impaired ability to cope with over-stimulating environments, low frustration tolerance;

    4. mood swings or emotional lability;

    5. impaired ability to establish or maintain self-esteem;

    6. denial or deficits affecting performance;

    7. poor emotional adjustment to injury (depression, anger, withdrawal, or dependence);

    8. impaired ability to demonstrate age-appropriate behavior;

    9. impaired  self-control (verbal or physical aggression, impulsivity, or disinhibition);

    10. intensification of preexistent maladaptive behaviors or disabilities.

    (7) functional skills-adaptive behavior, such as but not limited to, impaired:

    1. ability to perform developmentally appropriate daily living skills in school, home leisure, community setting (hygiene, toileting, dressing, eating);

    2. ability to transfer skills from one setting to another;

    3. orientation (place, time, situations);

    4. ability to find rooms, building, or locations in a familiar environment;

    5. ability to respond to environmental cues (bells, signs);

    6. ability to follow a routine:

    7. ability to accept change in an established routine:

    8. stamina that results in chronic fatigue.
       

  3. The functional impairments are not primarily the result of previously existing:

    (1) visual, hearing, or motor impairments;

    (2) emotional/behavioral disorders;

    (3) mental retardation;

    (4) language or specific learning disabilities;

    (5) environmental or economic disadvantage;

D. Information/data to document a functional impairment in one or more of the areas in item B must, at a minimum, include one source from Group One and one source from Group Two:

(1) GROUP ONE:

(a) checklists;

(b) classroom or work samples;

(c) educational/medical history;

(d) documented, systematic behavioral observations;

(e) interviews with parents, student, and other knowledgeable individuals;

(2) GROUP TWO:

(a) criterion-referenced measures;

(b) personality or projective measures;

(c) sociometric measures;

(d) standardized assessment measures; (academic, cognitive, communication, neuropsychological, or motor).

Current as of 01/31/05

 

Referral

Referrals come from a variety of sources, including parents, teachers school nurses, or the medical or rehabilitative communities. A referral must include medical documentation of a TBI diagnosis by a physician, to be kept in the student's due process file.

School Re-Entry

When a child is hospitalized as a rsult of a moderate or severe traumatic brain injury, the recovery process can be a long and arduous one for the child and family. It is extremely important that the health care professionals, parents and school staff work closely together throughout this period to assure a smooth re-integration from hospital to home and school. Please refer to the MDE Special Education Evaluation and Services for Students with Traumatic Brain Injury; A Manual for Minnesota Educators for further guidance.

Resources for Children with Brain Injury

Brain Injury Association of Minnesota
612-378-2742 or 1-800-699-6442
http://www.braininjurymn.org

The Brain Injury Association of MN is the only agency in Minnesota solely committed to enhancing the quality of life to people living with brain injury through education, support and advocacy.

PACER Center
612-624-2097 or 1-800-537-2237
http://www.pacer.org

PACER is a parent training and information center based in Minnesota that focuses on children's special education advocacy issues. They offer many workshops that can help you understand languages and terminology, legislative and funding issues regarding special education policy. They have an assistive technology resource library, an advocacy library, an advocacy library, an educational advocacy helpline and many other programs.

Brain Injury and the Schools:A Guide for Educators